**2.1. Program financing**

Development partners have always generously supported the maternal, child and newborn health programs in Pakistan [12]. Although the immunization program mainly depends upon domestic development funds, resources from donors (WHO, UNICEF, GAVI, etc.) have been instrumental too. Pakistan is the biggest recipient of GAVI at present, categorized as a Tier 1 priority country. GAVI financial support to the Pakistan government has been channeled through partner organizations, predominately, WHO and UNICEF [13]. The Government of Pakistan's own share represents approximately 20% of the total EPI allocations [6]. The Japan International Cooperation Agency (JICA) and the World Bank also support the program. Moreover, the donors have supported in-service trainings for EPI managers. However, delayed release of funds and inefficiencies in expenditure have been noted as some key issues in the past. Of particular note is the lack of appropriation for transportation and fuel costs. Shortage of funds for repair and maintenance of cold chain equipment and vehicles could jeopardize vaccine efficacy [13].
